LFT patterns & antibodies

Question 1

What does an ALT>AST suggest

Answer 1

Chronic liver disease

Question 2

What does an AST>ALT suggest

Answer 2

Cirrhosis and acute alcoholic hepatitis

Question 3

What are the LFT patterns for acute hepatocellular damage, chronic hepatocellular damage and cholestasis

Answer 3

Acute

• ALT: ++
• ALP: normal or +
• GGT: normal or +
• Bilirubin: + or ++
• Causes:
  
  • Poisoning
  • Infection e.g. Hep A or B
  • Liver ischaemia

Chronic

• ALT: normal or +
• ALP: normal or +
• GGT: normal or +
• Bilirubin: normal or +
• causes:
  
  • Alcoholic fatty liver disease
  • NAFLD
  • Chronic infection
  • Primary biliary cirrhosis

Cholestasis

• ALT: normal or +
• ALP: ++
• GGT: ++
• Bilirubin: ++

Question 4

What does an AST: ALT = 1 signify?

Answer 4

• Associated with ischaemia (CCF, ischaemic necrosis, hepatitis)

Question 5

What does an AST:ALT > 2.5 signify

Answer 5

• associated with alcohol hepatitis
• alcohol induced deficiency of pyridoxal phosphate

Question 6

What does an AST: ALT < 1 mean

Answer 6

• High rise in ALT - specific for hepatocellular damage
• Paracetamol OD w/ hepatocellular necrosis
• Viral hepatitis, ischaemic necrosis, toxic hepatitis

Question 7

What antibody titre is raised in PBC

Answer 7

Antimitochondrial